Healthcare Provider Details

I. General information

NPI: 1619312477
Provider Name (Legal Business Name): ARLINGTON DENTAL SLEEP THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E NORTHWEST HWY
ARLINGTON HEIGHTS IL
60004-6126
US

IV. Provider business mailing address

300 E NORTHWEST HWY
ARLINGTON HEIGHTS IL
60004-6126
US

V. Phone/Fax

Practice location:
  • Phone: 847-398-0811
  • Fax: 847-398-2987
Mailing address:
  • Phone: 847-398-0811
  • Fax: 847-398-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019023280
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH FAVIA
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 847-398-0811